血清淀粉酶和脂肪酶联合测定在急性胰腺炎诊断中的意义

目的探讨血清淀粉酶(AMY)和脂肪酶(LPS)测定在急性胰腺炎诊断中的价值。方法对51例急性胰腺炎患者、418例其他原因所致急腹症患者和78例健康对照组人员进行血清淀粉酶和脂肪酶测定。结果 51例急性胰腺炎患者中,AMY和LPS升高的敏感性分别为86.3%和92.2%。418例非急性胰腺炎的急腹症患者中,AMY、LPS升高和二者均升高的特异性分别为90.4%、91.7%和100%。结论联合测定血清AMY和LPS可提高急性胰腺炎诊断的敏感性和特异性,对急性胰腺炎的快速诊断具有重要意义。     

血清淀粉酶和脂肪酶联合测定在急性胰腺炎诊断中的意义

目的：探讨联合检测血清淀粉酶（AMY）和脂肪酶（LPS）在急性胰腺炎诊断中的意义。方法分别检测65例急性胰腺炎患者（AP组）、67例其它急腹症患者（非AP组）和60名健康对照组血清AMY和LPS水平。结果在诊断AP过程中,AMY的敏感性72.3%,LPS敏感性86.1%,AMY和LPS联合检测的敏感性96.9%;相对AMY单独检测诊断和LPS单独检测诊断,AMY和LPS联合检测诊断AP的敏感性明显升高（χ^2=15.127,P=0.000;χ^2=4.866,P=0.027）。结论联合检测血清AMY与LPS,可以明显提高AP的诊断敏感性。     

血清淀粉酶和脂肪酶联合检测在急性胰腺炎诊断中的应用

目的分析血清淀粉酶(AMY)和脂肪酶(LPS)检测方式在急性胰腺炎诊断中的价值。方法选取2012年1月至2014年2月收治的100例急性胰腺炎患者和100例健康体检者行AMY与LPS检测,分析检测结果及其灵敏度、准确度、特异度。结果重度急性胰腺炎组与轻度急性胰腺炎组患者的AMY、LPS水平高于对照组,差异有统计学意义(P0.05);重度急性胰腺炎组AMY、LPS水平比轻度急性胰腺炎组高,差异有统计学意义(P0.05);AMY、LPS联合检测的准确度、特异度、灵敏度高于两者单独检测结果。结论 AMY联合LPS检测可以为急性胰腺炎提供重要的诊断依据。     

4种血清标志物联合检测对急性胰腺炎的诊断和预后判断的价值

目的探讨血液淀粉酶(AMY)、脂肪酶(LPS)、C-反应蛋白(CRP)和白细胞介素6(IL-6)联合检测对急性胰腺炎(AP)的诊断和预后判断的价值。方法检测50例急性胰腺炎患者,包括28例轻型急性胰腺炎(MAP)患者和22例重型急性胰腺炎(SAP)患者入院时以及50例非胰腺炎急腹症(NAA)患者入院时和50例健康者的血清AMY、LPS、CRP和IL-6的水平,并检测50例AP患者入院后第3、5、7天血清CRP和IL-6的水平。结果入院时AP患者AMY、LPS和CRP水平明显高于NAA患者和健康对照组,差异有统计学意义(P<0.01),SAP患者IL-6水平明显高于健康组,差异有统计学意义(P<0.01),NAA患者AMY、CRP和IL-6水平明显高于健康对照组(P<0.01),但NAA患者LPS水平和健康组差异无统计学意义(P>0.05)。SAP患者CRP和IL-6水平明显高于MAP患者,差异有统计学意义(P<0.01),但SAP患者AMY和LPS水平和MAP患者差异无统计学意义(P>0.05)。入院后SAP组CRP和IL-6水平最高值均出现于第3天,SAP患者CRP和IL-6水平均明显高于同期MAP患者,差异有统计学意义(P<0.01),SAP患者和MAP患者治疗后第7天CRP和IL-6水平均明显低于同组入院时水平,差异有统计学意义(P<0.01)。联合检测AMY、LPS、CRP和IL-6敏感性、特异性和诊断符合率均明显高于单项检测,差异有统计学意义(P<0.01)。结论 AMY、LPS、CRP和IL-6联合检测有助于AP的早期诊断、病变程度的判断、治疗效果的观察及预后判断。     

血清AMY、LPS、CRP对急性胰腺炎患者诊断效能的影响

目的探讨血清淀粉酶(AMY)、脂肪酶(LPS)、C反应蛋白(CRP)对急性胰腺炎患者诊断效能的影响。方法选取2015年1月~2017年1月我院收治的急性胰腺炎患者124例作为观察组,依据患者病情严重程度分为观察Ⅰ组(轻症)99例和观察Ⅱ组(重症)25例,另选取我院60例同期健康体检者作为对照组。均行血清AMY、LPS、CRP检测,对比三组血清AMY、LPS、CRP水平,比较血清AMY、LPS、CRP单独诊断与联合诊断急性胰腺炎的灵敏度、特异度、准确度。结果观察Ⅰ组、观察Ⅱ组血清AMY、LPS、CRP水平均高于对照组,差异有统计学意义(P0.05);血清AMY、LPS、CRP联合诊断的灵敏度91.13%(113/124)、特异度85.00%(51/60)、准确度89.13%(164/184)均高于血清AMY、LPS、CRP单独诊断,差异有统计学意义(P0.05)。结论血清AMY、LPS、CRP可作为诊断急性胰腺炎的重要指标,三者联合诊断具有较高灵敏度、特异度及准确度,在急性胰腺炎早期诊断中有重要临床价值。     

MSCT联合血清AMY、LPS水平检测在急性胰腺炎患者病情评估中的应用价值

目的:探讨多层螺旋CT(MSCT)联合血清淀粉酶(AMY)、胰脂肪酶(LPS)水平检测在急性胰腺炎患者病情评估中的应用价值。方法:选取我院急性胰腺炎患者84例,其中轻度胰腺炎52例,重度胰腺炎32例,另选取同期健康体检者50例,均进行MSCT检查并抽取静脉血检测血清AMY、LPS水平,对比轻度胰腺炎组、重度胰腺炎组MSCT、AMY、LPS水平检测结果。结果:重度胰腺炎组、轻度胰腺炎组血清AMY、LPS水平均高于健康组,重度胰腺炎组、轻度胰腺炎组联合检测阳性率均高于MSCT、AMY、LPS单项检测,差异有统计学意义(P0.05)。结论:MSCT联合血清AMY、LPS水平检测可提高不同程度急性胰腺炎阳性检出率,有利于临床对病情准确评估。     

淀粉酶、脂肪酶和C反应蛋白联合检测在急性胰腺炎早期诊断中的价值

目的探讨淀粉酶、脂肪酶和C反应蛋白联合检测对急性胰腺炎(AP)的早期诊断价值,以及对病情严重程度的评估价值。方法选取2013年8月至2015年9月该院收治的AP患者60例作为AP组,并选取同期非急性胰腺炎急腹症(NAA)患者32例和健康体检者50例分别作为NAA组和健康组。检测各组血清淀粉酶(AMY)、脂肪酶(LPS)和C反应蛋白(CRP)水平,并进行比较分析。结果 AP组血清AMY、LPS水平分别为(791.9±444.1)、(443.2±119.2)U/L,均高于NAA组与健康组,差异有统计学意义(P0.05)。AP组血清CRP水平为(82.3±37.3)mg/L,与NAA组比较差异无统计学意义(P0.05)。3种指标联合检测用于AP早期诊断的灵敏度、特异度和准确度分别为81.4%、100.0%和90.7%,均高于各指标单独检测,差异有统计学意义(P0.05)。结论血清AMY、LPS和CRP检测有助于急性胰腺炎的早期诊断和病情严重程度的评估。     

C-反应蛋白对急性胰腺炎的诊断价值

目的探讨血清C-反应蛋白(CRP)在急腹症时对急性胰腺炎(AP)的诊断价值。方法将126例急腹症患者分为AP组68例和非AP(NAP,包括肠梗阻16例、急性阑尾炎17例和急性胆囊炎25例)组58例,同时测定血清淀粉酶(AMY)、脂肪酶(LPS)和CRP。绘制受试者工作特征(ROC)曲线,计算AMY、LPS和CRP诊断AP的敏感性、特异性、阳性预测值、阴性预测值。结果 AP组血清AMY和LPS水平明显高于NAP组(P<0.01),AP组和NAP组比较血清CRP水平差异无统计学意义(P>0.05)。LPS和AMY以正常参考范围上限的3倍(180、600U/L)为临界值时,其灵敏度、特异性、阳性预测值和阴性预测值均高于CRP(100mg/L),CRP的灵敏度、特异性、阳性预测值和阴性预测值分别为24.3%、60.8%、41.2%和39.9%。血清AMY、LPS和CRP诊断AP的ROC曲线下面积分别为0.937、0.943和0.458。结论血清CRP不能单独用于AP的诊断,结合临床症状和其他生物化学指标,对提高AP的正确诊断有一定的临床价值。     

血清CRP、淀粉酶联合脂肪酶检测在急性胰腺炎诊断和预后评估中的应用价值分析

目的 分析血清C-反应蛋白(CRP)、淀粉酶(AMY)联合脂肪酶(LPS)检测在急性胰腺炎(AP)诊断和预后评估中的应用价值。方法 回顾性收集2018年1月到2019年12月在我院就诊的AP患者315例,其中轻型胰腺炎(MAP)患者253例,急性重型胰腺炎(SAP)患者62例,另选取同期在本院体检的健康人群150例(健康组)以及非AP急腹症患者157例,对比不同人群、不同预后AP患者血清中CRP、AMY、LPS表达水平,以及CRP、AMY、LPS单独检测与联合检测对AP检出灵敏度、特异度、准确度。结果 (1)AP组、非AP组CRP、AMY、LPS表达水平明显高于健康组(P0.05),AP患者血清中AMY、LPS表达高于非AP组及健康组(P0.05),但CRP比较无差异(P0.05);(2)SAP患者血清中CRP表达明显高于MAP组(P0.05),AMY、LPS在两组中比较无差异(P0.05);(3)预后良好271例,预后不良44例,预后良好组患者血清CRP、AMY、LPS表达水平明显低于预后不良组(P0.05);(4)在三者单独检查中,两两比较差异无统计学意义(P0.05),三者联合检查对AP诊断敏感度提高、但特异度、准确度有所下降。结论 CRP、AMY、LPS在AP患者血清中均为明显高表达,三者联合诊断可有效提高对AP诊断敏感度,在患者病情程度、预后评估中有重要的参考价值。     

尿胰蛋白酶原-2对诊断急性胰腺炎的应用价值

目的探讨免疫层析法测尿胰蛋白酶原-2在急性胰腺炎诊断中的临床意义.方法收集347例急腹症患者血清和尿液标本,分别测定尿胰蛋白酶原-2和血、尿淀粉酶(AMY)活性,并将结果进行比较.结果尿胰蛋白酶原-2检测对急性胰腺炎诊断的敏感性、特异性分别为89.3%和90.3%,血AMY为80.2%和81.9%,尿AMY为74.8%和77.8%.尿胰蛋白酶原-2的敏感性和特异性均显著高于血、尿AMY检测.结论试纸法快速检测尿胰蛋白酶原-2诊断急性胰腺炎具有较高的特异性和敏感性,是筛选急性胰腺炎简便而快速的方法.     

血清淀粉酶和脂肪酶在急性胰腺炎中的应用

同时测定临床疑为急性胰腺炎的99例患者的淀粉酶、脂肪酶,运用统计学方法,分别计算出其灵敏度、特异度、准确度并比较。结果淀粉酶与脂肪酶联合测定的灵敏度、特异度、准确度,明显优于单独测定淀粉酶或脂肪酶。结论联合测定有利于实验室时AP的早期诊断。     

血清淀粉酶和脂肪酶联合测定在急性胰腺炎诊断中的意义

目的 探讨血清淀粉酶（AMY）和脂肪酶（LIP）测定在急性胰腺炎诊断中的价值。方法 对54例急性胰腺炎患者、58例胆结石患者、47例肾结石患者和50例健康对照组人员进行血清淀粉酶（AMY）和脂肪酶（LIP）测定。结果 54例急性胰腺炎中血清淀粉酶和脂肪酶升高的敏感性分别为87．0％和92．6％；联合测定AMY和LIP单项指标阳性率为98．1％；105例非急性胰腺炎患者中，AMY阳性的有12例，LIP阳性的有10例，AMY和LIP的特异性分别为88．6％和90．5％，AMY和LIP同时阴性的特异性为100％。结论 联合测定血清AMY和LIP可提高急性胰腺炎诊断的敏感性和特异性，对急性胰腺炎具有重要的诊断意义。     

Combined diagnostic value of biochemical markers in acute pancreatitis.

Eighty-three patients suffering from upper abdominal pain were studied to evaluate the contribution of commonly used biochemical markers in the diagnosis of acute pancreatitis. On admission to hospital, serum amylase, lipase, total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transferase activities were measured. By stepwise logistic discrimination, only two determinations appeared to be of clinical value: lipase and alkaline phosphatase activities. A classification rule was established including these two measurements and its diagnostic performance evaluated by a jackknifed method amounted .83%. ROC curves were used to assess sensitivity and specificity. Our study clearly shows that serum lipase measurements should be preferred to amylase measurements, and that our two-test classification rule provides an efficient aid in clinical decision-making.     

Lipase activity in serum measured with Ektachem is often increased in nonpancreatic disorders.

For patients with symptoms of pancreatitis, measurement of amylase in serum reportedly is more sensitive than that of lipase in acute pancreatitis, whereas lipase reportedly is more specific. However, serum lipase activities exceeding the upper reference limit (URL) have been reported for many patients who did not have pancreatitis. I reviewed the serum lipase and amylase concentrations of 493 consecutive inpatients and emergency department patients for whom both tests were ordered. Serum lipase and amylase activities, determined with an Ektachem 700 analyzer, were less than or equal to URL for 390 patients (83%) and greater than URL for 103. Medical records of 101 of these 103 were reviewed; 18 had acute or chronic relapsing pancreatitis. In this latter group, serum lipase values greater than URL had 100% sensitivity and 84% specificity; those of serum amylase greater than URL had 72% sensitivity and 88% specificity. However, the test combination of serum lipase greater than URL and serum amylase less than or equal to URL also occurred in 84% of the patients in which review of the medical records revealed nonpancreatic gastrointestinal or hepatobiliary disorders as the primary problem (n = 55). Therefore, serum lipase activity measured with the Ektachem assay is also often increased in patients with intra-abdominal disorders that appear to be nonpancreatic.     

血清脂肪酶测定对急性胰腺炎的诊断价值

目的探讨血清脂肪酶(LPS)在急性腹痛时对急性胰腺炎(AP)的鉴别诊断价值。方法将598例急性腹痛患者分为AP组192例和非AP(NAP,包括胆结石30例、肠梗阻15例、急性胆囊炎10例、腹部外伤9例、胰腺恶性肿瘤6例、不明原因腹痛299例、糖尿病6例、上消化道疾病11例、肺部疾病9例、急性肾功能衰竭11例)组406例,同时测定血清LPS和淀粉酶(AMY)。绘制受试者工作特征(ROC)曲线,计算LPS和AMY诊断AP的敏感性、特异性、阳性预测值、阴性预测值。结果 AP组血清AMY和LPS水平明显高于NAP组(P<0.01)。LPS和AMY均以正常参考范围上限的3倍(180、300 U/L)为临界值时,其灵敏度、特异性、阳性预测值和阴性预测值分别为87.5%、62.5%,89.4%、95.3%,80.0%、86.3%和94.7%、88.2%;血清LPS和AMY诊断AP的ROC曲线下面积分别为0.959和0.921,二者测定结果之间呈正相关(r=0.90)。结论血清LPS对AP的诊断性能优于AMY,对AP的诊断具有重要的临床意义。     

Evaluation of a new urinary amylase test strip in the diagnosis of acute pancreatitis

We have developed a novel rapid test strip for detecting pancreatic amylase in urine and prospectively evaluated its accuracy in screening for acute pancreatitis (AP). The test strip is based on the immunochromatography principle and uses two monoclonal antibodies specific for pancreatic amylase. Urine samples were collected from 500 consecutive patients with acute abdominal disease (52 with AP) and prospectively tested with the strip. The accuracy of the test strip was compared with that of two quantitative urine amylase determinations and a urinary dipstick test for amylase (Rapignost). Sensitivity of the test was 69% and specificity was 97% in differentiating patients with AP from those with acute abdominal extrapancreatic disease at admission. The negative predictive value was 0.986. The test showed moderate agreement both with an assay measuring total amylase activity and with another measuring pancreatic amylase immunoreactivity. At similar high specificity (97%), quantitative determination of total amylase activity (cut-off 3960 U/L) and pancreatic amylase (cut-off 2180 micrograms/L) showed lower sensitivity (54% and 41%) than the test strip (69%). The test is specific and rapid to perform, and it rules out AP with high probability. It could therefore be useful in an emergency setting without laboratory facilities in the differential diagnosis of acute abdominal pain.     

胰型淀粉酶、脂肪酶在急性胰腺炎中的临床应用

目的为了评价急性胰腺炎中胰型淀粉酶（P—AMY）的临床应用价值，对总淀粉酶（α-AMY）、P—AMY、脂肪酶（lipase，LPS）进行方法学评价。方法选择急性胰腺炎患者126例、其他疾病患者对照组105例、健康对照组95例，用日立7600全自动生化分析仪测定α-AMY、P—AMY、LPS。本实验室临界值定为α-AMY216 U／L、P—AMY 115U／L、LPS 200U／L。结果α-AMY、P-AMY、LPS灵敏度分别为73．1％、88．5％、92．3％，特异性分别为70．5％、81．9％、82．9％，ROC工作曲线下α-AMY、P-AMY、LPS灵敏度分别为65．4％、88．5％、88．5％，特异性分别为86．7％、80．9％、89．5％，α-AMY和P—AMY之间差异有统计学意义（P=0．045），P-AMY和LPS之间差异无统计学意义（P=0．613）。结论P-AMY检测比α-AMY更敏感、更特异性地反映急性胰腺炎。LPS也同样在急性胰腺炎中具有高灵敏度和特异性，临床上应同时检测P-AMY和LPS作为诊断急性胰腺炎的指标，具有更重要意义。     

The value of the amylase/creatinine clearance ratio in the diagnosis of acute pancreatitis.

Acute pancreatitis usually confronts the clinician with a difficult diagnostic task. For years, the primary laboratory diagnostic tests were the serum and urine amylase and the serum lipase determinations. Recent studies have introduced the concept of the amylase/creatinine clearance ratio as a means of increasing the specificity of the laboratory diagnosis. This paper reviews the laboratory evaluation of acute pancreatitis with emphasis on the rationale, derivation, and specificity of the amylase/creatinine clearance ratio.     

The Clinical Significance of Hyperamylasemia in Organophosphate Poisoning

Abstract

Objective: Hyperamylasemia with a presumptive diagnosis of acute pancreatitis has been reported following organophosphate poisoning but there are no large-scale studies incorporating more specific diagnostic criteria. Methods; Retrospective review of the medical records of 159 patients with a diagnosis of organophosphate poisoning over 3 years. Serum amylase, pancreatic amylase, salivary amylase, lipase and cholinesterase levels, and the clinical manifestations were analyzed. Results; Serum amylase data was available for 121 of the 159 study patients. Hyperamylasemia (amylase ≥ 360 U/L) was found in 44 patients (36%). Lipase was measured in 28 patients with hyperamylasemia; 9 of 28 had hyperlipasemia (lipase ≥ 380 U/L). The finding of hyperamylasemia was closely related to clinical severity and presence of shock. A presumptive diagnosis of painless acute pancreatitis was diagnosed by hyperlipasemia associated with hyperamylasemia, clinical severity, serum LDH, and leukocyte counts. Two patients with presumptive pancreatitis died. Shock, coma, and hypoalbuminemia were the factors predicting fatality. Conclusions: Hyperamylasemia is frequent in severe organophosphate poisoning. However, hyperamylasemia is not synonymous with acute pancreatitis and pancreatic amylase is not a reliable parameter in the diagnosis of organophosphate-induced pancreatitis due to its low sensitivity and specificity. Lipase assay is indicated in patients with hyperamylasemia for early diagnosis of pancreatitis. Proper image studies and even pathological examination are also needed to confirm the extent of pancreatic injury. With prompt diagnosis and appropriate treatment, a complete recovery can be anticipated unless the patient has otherwise unrelated complications.     

Variations in amylase isoenzymes and lipase during acute pancreatitis, and in other disorders causing hyperamylasemia

We compare the clinical value of assay of amylase (EC 3.2.1.1) isoenzymes with that of lipase (EC 3.1.1.3) in serum from patients with proven acute pancreatitis or with hyperamylasemia from other causes. In the former group we measured amylase, lipase, and isoamylases daily. Lipase and P(pancreas)-type isoamylases reached the highest mean values on the first day of an attack of acute pancreatitis (day one). Lipase declined rapidly, and by day four its mean activity was about the same as that of amylase and lower than that of the P-type isoamylases. Great inter-individual variations were found among patients with a similar clinical course. Of the 85 samples analyzed, amylase activity for 36 declined to within reference limits, but 18 of the 36 had high lipase activity, 18 had high P-type isoamylases activity, and 31 had P3 isoenzyme, which is not detectable in normal sera. Determination of isoamylases is a more sensitive index to acute pancreatitis than lipase assay and may be particularly useful when pancreatitis is suspected despite a normal total amylase activity. In the group of patients with hyperamylasemia from other origins, three had macroamylasemia, one had mumps, one had abdominal trauma without pancreatic injury, and one had pelvic inflammatory disease. The specific pattern of macroamylase on electrophoresis permitted a precise diagnosis of macroamylasemia; normal lipase had only ruled out pancreatitis. In the three other cases, lipase and isoamylases excluded pancreatic involvement.